Request for Policy Exception

Request for Policy Exception
Name*

First NameLast Name
Student ID #*
E-mail*
example@example.com
Phone Number

Area CodePhone Number
Program*
Policy Exception *
If Hours Per Week, Please enter how many hours you are able to attend per week.
If Other, Please Explain
Please provide a reason for your exception request.*
Agreement and Signature:

I understand that this form is to be used to determine an exception to STECH college policies; it is not a guarantee that an exception will be approved. STECH will notify me within (10) days whether the exception request has been granted or denied. A request must be filed within thirty (30) days of the occurrence of the circumstance upon which it is based. Any disputes regarding the determination will be addressed according to the STECH Grievance Policy.
Signature*

Clear
Should be Empty: